Postpartum Psychosis: Impact on Family

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Table of Contents

Introduction
Postpartum psychosis definition
Postpartum psychosis studies
Postpartum psychosis impact
Prevention and treatment
Conclusion
References

Introduction

Postpartum Psychosis is a typical psychological problem for many women and their families. The birth of an infant is a major life event and transition for parents, and usually influences many others close to the babys mother. By the ties of kinship, the extended families of both parents are often intricately involved in the pregnancy and maybe major sources of support for the pregnant woman. Close interpersonal relationships and social support are derived from their influence on how individuals cope with stress. These terms differentiate between support individuals believe to be available if they should need it and the amount of support that they receive or report to have received.

Postpartum psychosis definition

Some researchers suppose that Postpartum Psychosis is a psychological problem caused by the birth of a child. The other position is that: postpartum psychiatric illnesses are primarily a reflection of physiological changes, particularly endocrine changes, which occur during the first few weeks after childbearing (Hamilton and Harberger 15). Some experts have suggested that heightened levels of estrogen and progesterone in pregnancy make pregnant women more emotionally vulnerable, although the impact of hormones on prenatal mood has not been established empirically. For the most part, prenatal emotion has not been examined as a topic in its own right, but rather it has been described in the coverage of other topics, mainly in studies focusing on the impact of maternal emotion on birth outcomes or postpartum adjustment. In these studies, mean levels of emotion are often not reported, and when reported, are not usually compared to population means, or otherwise given meaningful interpretation (Hamilton and Harberger 2002). These studies may offer an inaccurate view of emotions in pregnant women of today due to important societal changes that are likely to have altered the experience of pregnancy. For example, more pregnant women are in the workforce now than in previous decades, which has affected societal views of pregnancy and the way women view themselves. Although the tendency to treat pregnancy as sickness has receded over the last few decades, pregnancy has been increasingly medicalized. Most women now routinely undergo prenatal tests such as ultrasonography, amniocentesis, chorionic villus sampling, and alpha-fetoprotein testing. There is conflicting evidence about whether such testing and the greater availability of medical interventions, provide reassurance to pregnant women or focuses their attention on the number of things that can go wrong. Because of these changes, research must be fairly current to accurately represent the emotional state of pregnant women today (Beck and Driscoll 2005).

Postpartum psychosis studies

Studies using standardized measures such as the State-Trait Anxiety Inventory have produced extremely similar estimates of prenatal levels of state anxiety, and the levels reported are close to published norms for these instruments for nonpregnant women. Thus, on average, pregnant women in these studies do not appear to experience elevated anxiety (Kleiman, 2008). However, study participants have been mostly socioeconomically advantaged, White, and married or partnered. There is conflicting evidence about whether anxiety is greater in women of lower socioeconomic status or other demographically at-risk groups (Hamilton and Harberger 2002). As with data on anxiety after pregnancy, information about depression is available almost exclusively from investigations conducted for other purposes. These studies, less numerous than those of anxiety, concur that most women do not experience clinical levels of depression after pregnancy. The more recent studies indicate that mean scores on the Beck Depression Inventory, the most common measure used, are below cutoffs for mild depression. pregnant women are not more likely to exhibit clinically notable levels of depression (minor or major) than nonpregnant women, but they do experience more depressive symptomatology, especially in late pregnancy. Thus, according to these results, pregnant women are likely to experience some emotional distress during the last trimester, but not at levels considered harmful or requiring clinical intervention (Mason et al 2005).

The study of stress processes in pregnancy involves a wide continuum of possible variables and outcomes for study. These can be broadly classified by the time of their occurrence into prenatal, labor and delivery, and postpartum periods. This developmental continuum can be extended to include postpartum conditions such as infertility and, at the other end of the continuum, parenting and child development. outcomes. Factors of interest after pregnancy can be further classified into maternal factors versus fetal and neonatal factors (Hamilton and Harberger 2002). Maternal prenatal variables include prenatal effect and well-being and maternal complications such as gestational diabetes and pregnancy-induced hypertension. Maternal labor and delivery outcomes include variables such as length of labor, mode of delivery, use of analgesia and anesthesia, and dysfunctions of labor. Maternal postpartum variables include postpartum depression, postpartum medical complications such as maternal hemorrhaging, and parenting variables such as difficulty in breastfeeding or caring for the infant. Fetal variables include growth and development parameters and fetal neurobehavioral maturation. Infant outcomes (at and after birth) include birth complications and infant health and behavior. Another important infant outcome is birth weight, which is described further later (Mason et al 2005).

Life events and state anxiety are the constructs most often assessed, but measures of depression and generalized distress also appear in the literature. In addition to these, quite a few studies have focused on occupational stress and physical strain or exertion. This work is relevant but not as well developed as research on life stress. Nonetheless, distinguishing physical exertion from psychological stress is very important to understanding mechanisms. Adverse outcomes may result in corn physical strain in strenuous daily activities or from perceiving that the demands of life stressors exceed peoples coping capacity. It is unlikely that physical strain and appraised stress have the same effects on physiology and outcomes of pregnancy (Kleiman, 2008).

Postpartum psychosis impact

Postpartum psychosis has a great impact on the family and a child. Multiple measures of stress (including life events, state anxiety, and perceived stress) were included in each assessment. Structural equation modeling methods were used to combine stress variables into a latent factor, providing the advantages of minimizing the effects of measurement error and using a common core of shared variance among stress measures as the predictor of outcomes (Stone and Menken 2008). The best latent factor to represent stress was composed of state anxiety, perceived stress, and ratings of perceived distress from life events. The total number of life events (or exposure alone) did not correlate with the latent factor or with outcomes. However, the latent stress factor predicted both birth weight and gestational age at delivery after controlling for medical risk factors including smoking (Mason et al 2005).

In addition, this study distinguished psychosocial resources (i.e., self-esteem, mastery, and dispositional optimism) from stress variables by assessing the former with standard scales and combining the scores into a latent factor. Labeled personal resources, this factor significantly predicted birth weight. Thus, stress was associated with length of gestation and not with intrauterine growth, whereas personal resources (mastery, self-esteem, optimism) were associated with birth weight and not length of gestation (Kleiman, 2008). Prior studies reporting significant associations between stress and birth weight or intrauterine growth have not controlled for personality factors or personal resources such as these, nor have they addressed the issue of confounding of different psychosocial constructs in multivariate analyses. Possible mechanisms explaining these effects are discussed, but briefly, it seems likely that different mechanisms are involved. Neuroendocrine and immune pathways are implicated in the stress-preterm findings in the literature, whereas behavioral pathways appear to be more promising in linking personality (or personal resources) and birth weight. As noted earlier, pinpointing the mechanisms responsible for links between psychosocial factors and birth outcomes is critical (Kleiman, 2008).

Family members suffer from psychological tension from the mothers side. In some cases overdependence occurs. It is an orientation based on a belief that others may not be available when needed (Kleiman, 2008). The overdependent individual seeks out and relies on more supports than are necessary or appropriate for the situation. Overdependence frequently leads to an individual relinquishing responsibility for personal well-being. Individuals who use an overdependent orientation may drain their social support relationships by their clingy nature and their failure to reciprocate. It should also be noted that if the client is acutely psychotic or is experiencing a life-threatening emergency, more radical intervention may be needed before the individual can work on in-depth understanding. In such cases, the creative aspects of the individual are relevant but tangential. The focus must first be on containing the immediate crisis (i.e., addressing suicidality, substance abuse, or psychosis as a primary treatment goal). Focus can then shift to work-related issues if they are relevant. However, even in treating a severely impaired creative client, the therapist must be sensitive to the nuances of the creative work process (Kleiman, 2008).

However, the fact that women on average do not experience high levels of emotional distress suggests that intervening factors moderate the influences of prenatal stress on womens emotional state. These factors may account for individual differences among pregnant women in levels of prenatal anxiety and depression. Coping, or the way that women manage problems during pregnancy, is one likely factor. Social. support is another commonly studied resource that may facilitate successful adaptation. Existing research on coping and social support in pregnancy is described next. It must be noted, however, that research on coping in pregnancy is in its infancy, whereas there is a considerable body of work on social support in pregnancy. A large number of studies substantiate that people who cope successfully with stressful situations are least likely to experience negative moods; conversely, maladaptive coping exacerbates or increases negative moods. The predominant view of coping is that it includes anything people do to manage problems or emotional responses, whether or not successful. Biopsychosocial approaches to the study of pregnancy and birth are accepted across disciplines, and interdisciplinary research collaboration is essential. Health psychology is in a unique position to contribute to this endeavor in the next millennium (Kleiman, 2008).

Prevention and treatment

The preventive intervention and treatment components of the preventive stress management model center on the public health and preventive medicine stages of primary, secondary, and tertiary prevention. Primary prevention aims to change the environment and manage organizational demands and stressors. Secondary prevention aims to change the employees and alter their responses to necessary and inevitable demands in the work environment. Tertiary prevention aims to heal individuals and/or organizations in distress. In addition to the stages of prevention as a basis for translation, public health and preventive medicine also offer the notions of surveillance, monitoring, and screening for use in an organizational stress context. Role stress and the identification of stress-related outcomes were dominant themes. The contemporary literature has continued somewhat in these traditions there are emerging themes that have evolved and flourished. Three of these themes are the changing nature of family relations, individual differences in the stress experience, and the role of family support. In Postpartum Psychosis, self-reliance is an orientation characterized by reciprocity and flexibility in relationships, and a pattern of interdependence. It is based on the belief that others will be available in stressful and anxious times of need (Hamilton and Harberger 2002).

Conclusion

In sum, inside the family, higher levels of support were associated with decreased incidence of these behaviors. Among personality and individual difference variables, higher levels of self-esteem, locus of control, and an intended pregnancy were associated with decreased incidence, and higher levels of hostility and defensive coping style were associated with increased incidence of these behaviors, respectively. In addition to these correlational findings, emerging evidence suggests psychosocial factors such as stress, depression, and partner support may play an important role in the success of prenatal intervention programs to reduce the incidence of these behavioral practices. Not only is stress ubiquitous in the course of living, but pregnancy entails several changes that women may find stressful, as described earlier.

References

Beck, Ch, T., Driscoll, J. W. (2005). Postpartum Mood And Anxiety Disorders: A Guide. Jones & Bartlett Publishers; 1 edition.

Hamilton, J. A., Harberger, P. N. (2002). Postpartum Psychiatric Illness: A Picture Puzzle. University of Pennsylvania Press.

Mason, Wendy A. Rice, Michael J. and Kathie Records. (2005). The lived experience of postpartum depression in a psychiatric population.: Perspectives in Psychiatric Care 41 (2), 52 (10).

Kleiman, K. (2008). Therapy and the Postpartum Woman: Notes on Healing Postpartum Depression for Clinicians and the Women Who Seek Their Help. Routledge; 1 edition.

Stone Susan Dowd and Alexis E. Menken. (2008). Perinatal and Postpartum Mood Disorders: Perspectives and Treatment Guide for the Health Care Practitioner. Springer Pub Co; 1 edition.

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